Administrative Page for

Blue Shield Employer Group Plans

Blue Shields Website forms & Applications

Compare one plan to another and even this year to last year!

Summary of Benefits

Plan Documents

2019 Underwriting Guidelines

If any links require log in, just email us [email protected]  and we will get you the form that you need.


Documents Library

Below is a cut and paste of what’s on Blue Shield’s website forms & Applications * or  Small Biz Library *

You can also check there or just email us [email protected] .

2019 Employee Application – January 1, 2019 – March 31, 2019 | Spanish
2019 Master Group Agreement – January 1, 2019 – March 31, 2019 | Spanish
2019 Network Guide
2019 Plan Cheat Sheet
2019 Request Contract Change – January 1, 2019 – March 31, 2019 |Spanish
2019 Subscriber Change Request – January 1, 2019 – March 31, 2019 | Spanish
2018 Employee Application – October 1, 2018 – December 31, 2018 | Spanish
2018 Enrollment Spreadsheet
2018 Enrollment Spreadsheet Guide
2018 Master Group Agreement – October 1, 2018 – December 31, 2018 | Spanish
2018 Network Guide
2018 Producer Agreement
2018 Request Contract Change – October 1, 2018 – December 31, 2018 | Spanish
2018 Subscriber Change Request – October 1, 2018 – December 31, 2018 | Spanish
Accelerated Death Benefit Claim
Access to Care
Additional Contact Designation: Notice of Lapse or Term of Policy for Non-Payment
Authorization to Disclose Health Information
Beneficiary Affidavit
Beneficiary Change Request
Eligibility/Participation Attestation
Standard Drug Formulary
BlueCard Worldwide International Claim
Book of Business Transfer Request
Broker Direct Deposit Authorization Form
Bundled Savings
Cal-COBRA Dental Election
Cal-COBRA Election
Cal-COBRA Take Over
Carrier Risk Management Assessment | Spanish
Changes To for HMO Mirror
Changes To for HMO Off-Exchange
Changes To for PPO Mirror
Changes To for PPO Off-Exchange
Changes To for PPO Savings Off-Exchange
Changes To Medical Plan Names
CMS Reporting
COBRA Employee Application
Continuing Group Coverage after Federal COBRA Cal-COBRA Election
Conversion to Individual Coverage of Group Life
CVS Caremark RX Mail Order
Declaration of Disability of Over Age Dependent Children
Dental Brochure for Brokers
Dental Claim
Dental Implant Benefit FAQ | Spanish
Dental Network Map
Dental Nomination Form
Dental Plan Competitive Highlights
Dental Smile Rollover Rewards
Direct Elite Rewards
Dismemberment Claim
Employee Change/ Cancellation Transmittal
Employer Notification of Qualifying Event under Cal-COBRA
EPIC Hearing Aid
Express Enrollment
Find A Doctor
Group Check by Fax Form
Group Information Update
Guide to Manage Dental Plan Online
Introducing Tandem PPO
Life Insurance Brochure for Brokers
Managing your Vision Plan Online
Member Guide to Orthodontic Coverage | Spanish
Notice Informing Individual about Nondiscrimination and Accessibility Requirements
Notification of CMS Reporting Requirements
Online and Mobile Tools
Pediatric Dental and Vision Coverage
Pharmacy Reimbursement
Premium Only Plan (POP)
Preventive Health Drugs Preventive Health Guidelines | Spanish
Print or Order ID Card
Privacy Policy | Spanish
Proof of Death
Quick Match Program
Rate Disclosures January-March 2018
Rate Disclosures October-December 2017
Refusal of Coverage
Relaxed Participation
Request for COC Notice – HMO Enrollees
Request for COC Service – Members or New Enrollees
Sales Brochure – Q1 2019
Sales Brochure – Q4 2018
Sales Brochure – Q3 2018
Sales Brochure – Q2 2018
Small Business Tiered Pharmacy Network CA Level A Pharmacy Directory
Shield Concierge
Small Business Online Roadshow Presentation | Recording | Questions Answered
Small Group Producer of Record Change Request
Sole Proprietor, Partner of Corporate Office Statement
Specialty broker bonus
Specialty Drug List for Standard Drug Formulary
Specialty Wellness Discounts
Subscriber Statement of Claim
Subscriber Statement of Claim – Life
Summary of Benefit FAQ
Tiered Pharmacy Network
Trio Flier
Trio Qualification Tool
Total Health and Wellness | Spanish
Vaccine List
Vision Brochure
Vision Claim
Vision Network at a Glance
Vision Plan Info Card for CA Members | Spanish
Vision Plan Info Card for Out-Of-State Members
Waiver of Premium Claim
What’s New – Q1 2019
What’s New – Q4 2018
What’s New – Q3 2018
What’s New – Q2 2018
Why Blue Shield | Spanish
Why Blue Shield Small Business
Women’s Preventive Health
Easy steps to print or order your ID card (PDF, 349KB)
Online and mobile tools (PDF, 575KB)
Access to Care (PDF, 101KB)
2018 Group Administrator’s Guide   A comprehensive guide for your clients that covers a range of information from a list of contacts to instructions for enrollment, payments and other processes.


Click here to get  Instant ONLINE quotes, just by just entering your census.

Click here for    Current Sales and Enrollment Information.

Our Renewal Center * or this link *   is your single source for renewals, quotes, and maintenance. With our new streamlined renewal process, you now can:

  • Compare/add/edit/delete subscribers and dependents to calculate quotes..

Quotit Enrollment, Applications  & Misc. Forms Scroll down the page to Blue Shield

Find EOC’s – Evidence of Coverage for Employee Distribution

eligibility support line at 800-303-5921  

Producer Connection:


For All Renewal Forms and Benefit Summaries.

GROUP SERVICES: Confirm Member Enrollment and Terminations Phone – 800-325-5166, option 1 Producer’s Online Client List:

SUBMITTING GROUP CHANGES/REQUEST FOR CHANGE FORMS: Fax – 209-367-6603 (please retain your fax confirmation) EMAIL: [email protected]


BILLING QUESTIONS? Phone – 800-325-5166

groups 1-100, Group Employer Services: (800) 325-5166
View a Quick Reference Guide


CLAIMS AND BENEFIT QUESTIONS: PPO DMHC Plans – 800-200-3242 HMO/POS – 800-424-6521


Cal – COBRA: Phone – 800-228-9474.  


Enrollment Forms 

Quotit Paper - PDF

Scroll down for what you need 

Forms are in Alphabetical Order by Insurance Company


Pro Apply

Pro Apply

ONLINE Enrollment Tools - Instructions
This is a directory listing and may be confusing

Email us for a web  link to get your applications going with Pro Apply

Employee Guide_Pro Apply
Pro Apply_Intake Form
User Guide_Pro Enroll_Broker

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2 comments on “Administrative

    • Blue Shield of California will be sending rebates to 40,000 small group plan holders. The MLR Medical Loss Ratio for small groups insured by Blue Shield was 79.7%. Because Blue Shield missed the 80% target by 0.3%, it will refund 0.3% of the total health plan premiums paid by the employer and employees in those plans.

      The following subscribers and employer groups will not receive 2018 plan year rebates, since Blue Shield met or exceeded the MLR targets for those health plans.

      Individual and Family members with Blue Shield of California Life & Health Insurance Company (Blue Shield Life) and Blue Shield plans
      Small businesses with Blue Shield Life
      Large groups with Blue Shield Life and Blue Shield plans


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